Friday, November 19, 1999

EPM: Lessons Learned. Part I Diagnosis - Karen Gehringer

I have spent the last seven months treating my horse for EPM. We should be done with treatment in two days. Anna looks really good now but I have a strong urge to knock on wood as I type that because relapse is always a possibility.

I would like to share with you what I have learned through this process because, chances are, more than a few of you will have to deal with EPM at some point. Maybe my experience can be of some benefit to you and your horse.

I would like to divide this up into several parts. The first would be “diagnosis”, the second “treatment”, the third “food for thought” and the fourth “resources”.

Part 1: Diagnosis

In mid March of 1999, Anna and I completed our first one day 50 mile ride at the Florida Endurance Classic. We went slow but I was so pleased that she came through with one B and the rest A’s. I was thrilled as this was a big step for my mare and I. The vets were excellent and since there was an FEI part to the ride, no doubt very qualified.

After a week or so of time off, it was back to work. Anna wasn’t quite right. Soon she was intermittently traveling crooked, with her hind end traveling several inches off to the left of her front end. After checking to see if the heart rate monitor was bothering her, then checking for saddle problems, I called my vet, Dr. Suzan Oakley. She came out the first part of April and made the diagnosis of EPM. The diagnosis was made due to muscle atrophy in the right shoulder and mild atrophy over the gluteals. Anna had proprioceptive deficits in all four legs (moderate delay in the front, extended delay in the hind). Tail pull was weak and she had a distressed facial expression. Should be noted that I rode her hard for 45 minutes (turns on the haunches, forehand, tight circles, backing etc) before I could get her to travel crooked prior to the vet’s arrival.

My vet started Anna on pyrimethamine/sulfadiazine 30 ml a day. She also gave her the rabies shot she was due which may or may not have been such a great idea at that point, but more on that later.

A month later she showed mild improvement to my vet. But to me, she was worse as it took no effort at all to get her to travel crooked. Although I believed my vet’s diagnosis because she is a skilled diagnostician and I had a gut feeling she was right, I decided at this point to get a second opinion.

My neighbor’s horse had just been diagnosed with EPM also so we took them both up to the University of Florida vet school. Dr. Maureen Long, a neurologist, saw Anna. She did a spinal tap on her, x-rayed her neck and did a neurological exam. The results were that Anna has some arthritis in her neck which may or may not be effecting her (although I bet that’s why she couldn’t do dressage)plus she had mild weakness in the RF,LH and RH and mild proprioceptive deficits. The spinal came back as a strong positive for EPM. Dr.Long recommended continuing the treatment my vet started. As a side note, Dr. Bryant who vets alot of rides checked on my mare several times while we were at UF and I really appreciated that courtesy. Although both vets felt they had enough to go on to diagnosis EPM, there is no definitive way to prove a horse has it. Some horses with positive spinal taps show no symptoms at all. No one really even knows what causes EPM. Recent controlled studies at UF failed to induce EPM in healthy horses.

My next post will cover a comparison of tx options (including cost), supplements, rehab and other tx considerations.

EPM: Lessons Learned. Part II Treatment - Karen Gehringer

There are three important points to keep in mind during the treatment phase. First of all, don’t give up. Your horse might look really hopeless at some points during treatment (i.e. unable to keep his balance) or have phases where she looks really good followed by serious backsliding. This can be heartbreaking and frustrating. However, sometimes the horses that look the worst off recover the quickest. And horses like mine, who have milder cases, can take a long time to heal. Nobody knows why this is the case but the key here is persistence. Secondly, be flexible. What works for the horse down the road may not work for yours. This is a highly variable process. Thirdly, be prepared to spend some bucks. I still refuse to total the cost because I really don’t want to know how much I’ve spent. All that said, I’ll move on to the medications.

I am familiar with the traditional medication (pyrimethamine/sulfadiazine) and Baycox (aka Toltrazuril). There is also a new medication called NZT but I am not familiar with it. My vet and the vet at UF recommended the traditional medication so that’s what I used for 6 months. It is an antibiotic that works by boosting the immune system to fight the protozoa (as I understand it). It costs $140 a month, give or take what mark up your vet tags on. In addition, you will add on monthly vet checks with anemia levels drawn. This treatment typically lasts 6-12 months. My horse seemed to get better, slide back, get better, slide back an infuriating amount of times. This can be caused by the die off of protozoa which temporarily worsens symptoms. The medication is a pain to deal with because it has to be given on a relatively empty stomach (2-3 hours after food has been ingested and no food given 1 hour after administered). You have to drench the stuff which most horses think is nasty tasting then not give them any treat afterwards. I’m surprised my horse still likes me after me starting every morning for 7 months coming at her with a syringe of the stuff. By the end of six months on this, Anna was traveling straight about 95% of the time, her placing test on the front feet was normal and she was only slightly delayed on the hind legs (used to take her 4 seconds to figure out her legs were crossed and how to uncross them, at that month it was less than a second-not quite normal but close). I can describe this test if anyone is interested. Her gluteal atrophy was gone, her attitude much improved and her rear end was stronger. She still had mild shoulder atrophy. By the way, the sooner you catch this thing, the better your odds are of healing the atrophy. At six months, I was faced with three to four more months of treatment. However, my neighbor’s horse had steadily declined on the traditional meds and had switched to Baycox. She had dramatic improvement on the Baycox in a very short time. More was known about Baycox at this point so I decided to get the Baycox and combine it with one last month on the traditional meds. My vet, after seeing the results with my neighbor’s horse, was in full support of this.

Baycox is a new drug that has not yet been approved by the FDA but can be special ordered by your vet through Bayer in Canada. The flat cost is $550 for a 28 day treatment including shipping. Your vet can of course mark it up to whatever the market will bear. Pray that your vet has mercy on you. This drug actually goes in and kills the protozoa directly (as I understand it). It usually takes 28 days to treat a horse. There appear to be no side effects with this medicine. It is easy to administer; I just pour it on Anna’s feed or you can drench it. The only problem I have heard is with relapse. This may be connected with insufficient dosing. It says to give 50 ml per day to any horse. I think that may be fine for my Arab but a heavier horse may need a bit more. Anyway, there are alot of unknowns because this is a new treatment. If I had to do it over again, I would start with the Baycox. After three weeks of Baycox, Anna could full out gallop a 15 meter circle around me leaning like a barrel horse. She looked completely normal to the left and only showed some slight weakness to the right in her left hind but this was at a full gallop. Her strength may improve since she’s had 7 months off but even if it doesn’t, her lasting effects at this point appear to be minimal. Her placement test is also normal now and her shoulder atrophy is improved.

No matter which treatment you chose, it is highly recommended to supplement with Vit E. KV Vet supply has a Vit E 8,000 designed to be the right dose for EPM treatment. It costs $70 for a 4lb container. Anywhere from 8,000-10,000 I.U.s is recommended. I used the E 8,000 but also used an E/Se supplement because we are Se deficient in Florida. Be careful not to over do the Se when adding E because the Se can be toxic. I used Lixotonic (like Red Cell) from Anico Vet Supply to keep my horse from getting anemic (she never did) and Fast Track probiotic to protect her stomach. My neighbor used an immune booster from Meadow Sweet Acres Herbs that she liked (didn’t go over well with my horse) and flax seed (which I am going to try). Some people use Equistem or Levimisole but I have no experience with either of those.


According to the UF vets and an article on EPM rehab in The Horse magazine, you should continue to work your horse on a limited basis to prevent further muscle atrophy. No doubt this is good advise for some horses but, if I were to do it again, I would leave my horse alone (with turn out) and let her heal. As it was, I did light riding for a time but I could tell this was not helping matters. When Anna acts tired there is something very wrong so I did not “push her through it” as advised. I tried lunging which didn’t work and stressed her out because she didn’t have good enough balance to do it, poor thing seemed to feel embarrassed. So I tried ground driving which was tiring for me and didn’t seem to help her. Then I tried some TTouch techniques (promise wrap, stretches, varied heights of cavalletti designed to get her to realize where her hind end was), Anna was very patient with all this but I don’t think it had much effect. Any of these ideas may work very well for another horse but Anna got better when I finally quit worrying her and left her alone. Grooming and sweet talk seemed to comfort her though. Some horses get really grumpy and sensitive during treatment so you might even need to minimize grooming.

I kept a journal of how Anna was doing so that I could see any patterns to her recovery. That helped me to remain a bit more objective and not lose hope. I also took pictures of her from the sides and down along the back so that I could compare any changes in atrophy.

Vaccines and Wormers during Treatment

The rabies vaccine and /or starting treatment wiped Anna out for an entire week. Given that the immune system is already stressed, I would avoid all vaccines during treatment. That is my opinion only and I’m not a vet.

As for wormers, Ivermectin and Quest tend to really set horses back that are being treated for EPM. Anna was not herself for three days after using Ivermectin. Panacur did not seem to adversely effect her and has been used with no ill effect on other EPM horses. However, I am now having fecal checks done and, unless I start to see worms, I’m not worming at all. If I do, I will likely use Strongid once a year and Panacur the rest of the time.

In the next section, I will include some thoughts on prevention.

EPM: Lessons Learned. Part III Prevention - Karen Gehringer

The current thought is that EPM is caused by horses ingesting possum feces which contains the EPM protozoa that they got from eating infected birds. This theory has yet to be proven in a controlled study. A study at U of Florida failed to produce EPM in healthy horses. Now there is the thought that horses who are unable to fight off EPM protozoa have a problem with their immune system. But nobody really knows why some horses get it and others who are treated identically don’t.

On the EPM horse list, many horse owners report that their horses became symptomatic after being wormed or receiving vaccinations. I know that vaccines and wormers are around for a reason, to protect horses from deadly diseases. And I also know that correlation does not prove causation. The timing could be coincidental. For myself, however, I am rethinking my approach to vaccines and wormers; perhaps more is not better.

I am going to worm my horses only as necessary from now on depending on fecal counts. I used to worm every 7 weeks. I also plan to do some serious thinking about vaccines and narrow them down to the bare necessities. When I do use vaccines, I will avoid the 3 or 4 in one type and I will space them out generously. I had spaced them out before but I had one, possibly serious error. My horse always reacted badly to the strangles shot so I decided to try the intranasal vaccine. I didn’t know it was a two part series the first time so the second in the series was given one week before the FEC 50. I can’t help but wonder if dealing with that vaccine combined with the stress of the ride compromised her immune system’s ability to fight the protozoa.

If the possum is the main carrier of EPM, the trick is prevent the horse from ingesting possum feces. This is not so easy to do because it can be in the hay you buy or out in your pasture. One simple strategy would be to contain your feed in metal containers or trash cans with lids. That reduces the temptation for possums to arrive at your barn. Also, keep your hay in some sort of enclosed area. Dogs and cats can serve as deterrents but don’t count on that because possums can be mighty bold. Finally consider using fencing that makes it tough for possums to get inside, like wire mesh, and regularly check for holes underneath it.

I sure do wish that I had had health insurance on my horse but I didn’t because “my horses never get sick”--famous last words. Having insurance gives you freedom from the financial stress of treatment and provides you with more options if you aren’t always having to check your bank account or reach for the credit card before you decide to try something new.

In the last of this series, I will share some resources for more information about EPM.

EPM: Lessons Learned. Part IV Resources - Karen Gehringer

Here is a list of resources for further information about EPM:

1. This site gets about as detailed as most people ever want to get on a subject. Highly informative.

2. In the knowledge bank section there are several good articles about EPM. You can also down load the form needed to order Baycox.

3. He is a vet at Bayer who can answer all your questions about Baycox.

4. This is a support group list for EPM horse owners.

My best resource has been my long suffering husband who never once questioned me about the cost of this thing and only razzed me occasionally about my obsession with it. Also my fellow horse loving friends, Mary Marshall, Edie Whiting, Becky Siler, Donna Shoaf, Linda Flynn and Jeanie Miller have been a huge support to me and I am grateful to them.

Anna had her first day without meds today. Any prayers, good thoughts or positive chi you could send our direction would be greatly appreciated.

Happiness and Health to all,


Tuesday, November 16, 1999

Money Enough and Time - A Report From Rural Vermont - John B. Ayers

Our competitive equestrian season is over and the Power Company shut off our electric for the day to upgrade the lines. We have no water, no furnace, no light and no TV. The battery in my laptop is fully charged and the phones are working so it seems like a good time to thank all of you for your inspiration and assistance and to report on our progress over the past two years.

To give you the setting, I started a fire in the old-fashioned cookstove and it`s warm and comfortable in the country kitchen of this 200-year-old farmhouse. The temperature outside is near freezing. Our most recent snow has melted but we can still see it on the mountains to the west. We live on 100 acres and are in the last house on the paved road with miles of gravel roads and trails on which to ride and drive. This part of Vermont is called "The Northeast Kingdom".

In May of 1997, at age 66, I knew nothing about horses or riding or driving. I started taking riding lessons and a few months later bought Meshack, a six year-old green-broke Arab pasture potato. We finished this season with two ribbons for Reserve Champion---one for CTR and one a Horse Show with riding and jumping, also a Blue Ribbon for Advanced Trail Class. This summer we started driving, entered several driving competitions and took two second-place ribbons. I can`t begin to tell you what an incredible feeling of accomplishment it is to have this animal develop into such a versatile athlete! It did a lot for my physical and mental health as well. I joined a health club to get in better physical shape. After I bought Meshack, several friends and family members suggested psychiatric counseling, but after meeting several other equestrians, I felt that some mental instability was an asset in this sport.

Over the past two years I learned three things of significance:
1. The Internet is an incredible resource for help on riding, driving, equestrian health, and to make some wonderful friends.
2. Having a horse that`s willing and intelligent makes it easy to afford professional help. I have been fortunate to have worked with some of the best here in the northeast and can never adequately express my appreciation!
3. Riding a horse is a lot more challenging than riding a bicycle, and it`s very important to keep the horse between the ground and me!

This summer we started "fine tuning" which included a switch to Nutrena "Compete", a mullen mouthpiece, running martingale, equine dentistry, new saddle, new farrier and developing his rear. For those of you interested in the details I`ll elaborate below. The rest can hit "delete" with my sincere thanks and appreciation for any help that you provided!

The switch to Nutrena was an accident. We won five bags and began to notice that he was much less "hyper". We think this was due to eliminating molasses and possibly the higher fat content.

We asked one of the trainers to try different bits after she questioned the full cheek snaffle we used for riding and the half cheek snaffle we used for driving. He really seems to like the eggbutt mullen mouthpiece for riding and the Liverpool mullen for driving.

The running martingale encourages him to keep his head lower and seems to give me that slight increase in control when he starts to get into the "Competitive" part of Competitive Trail Riding.

It took two vets, an equine dentist and his apprentice to get the teeth right. The second vet tranquilized him and clamped his mouth open to finish the bit groove and eliminate sharp edges toward the back of his mouth that were causing some bleeding.

His conformation changed dramatically over time, particularly after we started driving. My search for the fourth saddle in two years is another story, but we now have a used Smith Worthington all purpose model that Meshack and I both like. I thought that the last one was a good fit but now realize that the stirrups were too far forward making posting a real effort. If you haven`t done the arithmetic, in a 25-mile CTR you post 8000 times! The "Test" is being able to stand up in the stirrups.

The new farrier is doing the "Four-point" or "Natural" method with clips and trailers. It has almost eliminated his stumbling and lost shoes. The shoes are set back almost to the white line and the toes are squared off.

Several competitors recommended driving, in that the cross training would strengthen and teach him to use his rear. It made an incredible improvement in his ride. In addition we discovered that we both enjoy driving and driving competitions

It has not been easy being an elderly male in a sport dominated by attractive young and middle- aged females. It really hurts when so many see us and say "what a beautiful horse". They NEVER say anything about a beautiful rider!! (One Ridecamp member suggested that you could at least comment on how I "sit tall in the saddle with an aura of confidence and control"). Anyhow, it is almost worthwhile since we found a picture of Meshack and me driving with five year-old GREAT granddaughter, Kaelyn, on the cover of the Carriage Driving Rogues Gallery: ( ). Also look under "A" for Ayers.

My report would not be complete without mention of the quest for "Male Comfort". I was a bit concerned initially when a woman in San Diego suggested gelding (THE RIDER!). Another suggested Viagra, which sounds okay but is expensive. I have a theory that those parts get numb after a few hundred miles and the problem is greatly diminished (pun intended). If ordered on penalty of death, to father a child at the end of a 50-mile ride I would be doomed. I settled on good-fitting jockey undershorts and like to wear tights at least in competition. At the risk of being misunderstood, I would dearly love to have a little more of the padding with which female competitors seem to be blessed (you never thought of it as an asset?? pun intended).

In exasperation, while trying to learn the "Two Point", I told my instructor that if I ever mastered it my next big challenge would be to try sex standing up in a hammock. I am happy to report that I can now do four jumps in succession, at the canter, in Two Point! Unfortunately my wife does not ride, and only an equestrian would have the combined skills for such an event. A bigger challenge might be convincing her that we could recover the money I`ve spent because Meshack will generate $10,000 in fertilizer for her flower gardens. She thinks THAT concept is a lot of horse manure!

During a challenging business career, I dreaded retirement, wondering how I could occupy my time. I read recently that to be happy you need something to do, someone to love and something to look forward to. I would add financial security and good physical and mental health. This equestrian activity has provided the missing ingredients for my happiness. In addition, I`ve met many really great human beings. For the "look forward to" all we need do is enter the next competition.

Our next competitive season starts in January (the start of my 70th year) with the Vermont Riding and Driving Association`s "January Thaw". We can expect weather about as extreme as can be found in continental U.S. This year we rode in freezing drizzle and 3" of slush (like sand for you desert folks) and took Third Place. I have heard that in past years riders took turns blowing on the thermometer to get it up to the start minimum. I considered driving the next one, but when one of the members told me how cold he got driving the CTR in the rain on October 23rd, I decided to ride. We were comfortable riding in the rain and cold.

We hope to do many more CTRs, maybe a 50-mile endurance ride and a hunter-pace, at least two horse shows and two driving competitions next year.

The happiest day of my equestrian career was the day Meshack trailer loaded! He now walks on past me and stands quietly while I close the butt chain. How we got to this point is a story in itself. Two years ago I would have told you it was impossible!

The second happiest day of my equestrian career will be the day we finish a 50 mile endurance ride and Meshack behaves for 49 miles of it (give him the first mile to settle down). Angie McGhee will tell you that`s impossible as Meshack and Kaboot are physical and mental twins. If it happens, I hope you`re there to see it!!

If all the above sounds like self-promotion, I won`t deny it, but will tell you it`s been a real lesson in humility!

Happy Trails,

John and Meshack (See my photo in the birch trees) (Vermont Equestrian Activities)

Saturday, November 13, 1999

Appreciate Every Day With Your Horse - Laura Curtis

TRUE TALES, by Laura Curtis

I was glad I had my sunglasses on; I didn`t want my vet to see me crying. The vet had just finished a rectal exam on my horse and was giving me the bad news. Dakota is my fiery bay Arabian gelding. We have been together ten years now. When I got Dakota, he was four years old, recently gelded, and well on his way to an unpleasant end. He had gotten aggressive and quite explosive to any provocation imagined or real due to mistreatment. Together, after lots of patience and time and love, he and I became the best of friends; he would do anything I asked of him. I had even had people walk up to me and ask to buy him for their children--quite a metamorphosis from his previous self. My life has revolved around this horse since I bought him--I love him dearly.

Last year while out trail riding he began to wring his tail. I thought perhaps he had dry skin although he showed no indication of it. Dakota is an extremely sensitive horse. For instance, he cannot tolerate square saddle blankets because he can`t stand the occasional touch of the corner of the blanket. He tends to react rather explosively in relation to the irritant--the touch of the corner of a square saddle blanket would launch him into a fit of bucking. So, I began to feed him corn oil. His aggravation and tail wringing only worsened while out riding. He also began to buck--not his usual `I`m happy to be alive` buck, but an unhappy, `something is bothering me` buck. I talked to my vet, and he suggested a fungal shampoo every day for 14 days. Maybe Dakota had seborrea, although again he showed no sign of it. We tried that to no avail--back to the vet who then suggested an anti-bacterial shampoo for 14 more days. This didn`t help either. Dakota had progressed to the point of being unridable. He would refuse to move at all after about 20 minutes of riding--even when I dismounted and tried to lead him home. He seemed to show no discomfort, however, when free in his paddock. The trigger for the behavior was either weight on his back or possibly the cinch. When I unsaddled Dakota, he would bite viciously at his sides, especially his right side. When I groomed his back over the loin area, he`d stretch his head up and roll his eyes, like I was scratching a terrible itch, and it felt so good. Something was definitely wrong--we just had to figure out what it was. I called my vet again who vaguely suggested that perhaps it was something to do with my tack or perhaps my saddle blanket was irritating Dakota. I tried not to get upset about this suggestion. I know my horse, and it was definitely not my tack. It had now been close to a year since the onset of Dakota`s vague but troubling symptoms. Nevertheless, I purchased a new saddle blanket that was a different material than what my previous blanket was made of. It did not help. Again I called my vet and persisted that we look further. Our next step was to take a skin biopsy to check for allergies. He did show some indication of allergies, so we did a blood test. Dakota showed up as being mildly allergic to barley, which I was feeding him, and grass hay, which I had also been trying to feed him, but which he wasn`t eating very well. My vet said that even though Dakota was not reacting strongly to these two items, they might be bothering him enough to cause Dakota to display that behavior that he was. We changed his diet to eliminate everything he was allergic to.

Several months later he was still no better. My vet came out to examine him once again. After pausing for several seconds in thought, he noticed that Dakota`s sheath was slightly enlarged, which I had noticed, too. I had also noticed that Dakota`s stream when he urinated was not as strong as it used to be. Both of these symptoms came on quickly--within two weeks. My vet decided to do a rectal exam. Sure enough, he could feel a large mass above Dakota`s bladder, and the bladder which normally is paper thin membrane felt thickened to my vet.. We then decided to take him in for an ultrasound and biopsy. The tumor turned out to be a lipoma which is a fatty tumor. Unfortunately, it`s location precluded it`s removal as it was sitting right on top of a large nerve bundle. Dakota has now developed these fatty tumors in his girth area in addition to the internal one we now knew about and the ones on his sheath. We did a urinalysis which turned out normal. Dakota bites at himself like he`s itchy. He rolls frequently. He does not run madly around his paddock with his tail flagged as often as he used to. He yawns often which my vet told me can be a sign of discomfort in horses. But my vet said that he could live a long life--I just can`t ride him anymore. I was devastated. I had always thought that if we just kept looking we would find and fix the problem. I never dreamed it would be something we couldn`t fix. We have to watch Dakota now and when the time comes that he`s no longer comfortable, I`ll have to call my vet again to put him to sleep. I have since found out that a significant number of colics that progress to surgery turn out to be these tumors.

I had ridden Dakota constantly since I had gotten him. We had the best times together. He was my escape, my salvation, my friend. Appreciate every day with your horse; we can`t take those moments for granted.